Strep A and scarlet fever

What to look out for

Scarlet fever is an illness caused by a bug called Group A Streptococcus, which is found on the skin and in the throat. Scarlet fever mostly affects children and can easily spread to other people.

Generally, scarlet fever is much less common than it used to be but in the last few years there have been a number of outbreaks.  It is important that children with scarlet fever are assessed by a healthcare professional so that they can be started on antibiotics.

The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 days. The rash may be harder to see on darker skin tones. It often feels like 'sandpaper' but is not itchy.

Your child may also have a:

  • Sore throat or tonsillitis
  • Fever (temperature of 38°C or above)
  • Painful, swollen glands in the neck

  • A red tongue (strawberry tongue)

    ​​​​If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.

Scarlet fever - new image.pngIf you think that your child is likely to have scarlet fever, you should by reviewed by a healthcare professional.

Does your child need antibiotics?

If a healthcare professional thinks that your child has strep throat or scarlet fever, they will prescribe your child antibiotics. This reduces the chance of their infection becoming more severe but more importantly also stops them spreading the infection to others (after 24 hours of starting antibiotics), especially to people at higher risk of severe infections such as the elderly and those with weakened immune systems.

My child has been in close contact with someone with Strep A - do they need antibiotics?

If your child has been in close contact with a case of scarlet fever or strep throat, they do not need to be treated with antibiotics unless they are showing signs of infection (severe tonsillitis with fever in the absence of a runny nose or signs of scarlet fever). Only in exceptional circumstances will the local public health team recommend for an entire school class to be treated with antibiotics.

My child has been diagnosed with scarlet fever or strep throat and is on antibiotics - what do I need to look out for?

Your child may continue to have a fever for a few days after starting antibiotics. Very rarely, Group A streptococcus can spread to other areas of the body (invasive group A strep), causing infections in the neck (tonsillar abscesses or lymph node abscesses), behind the ear (mastoiditis), chest infections (pneumonia), bone and joint infections (septic arthritis) or sepsis. Look at the red /amber /green information below to help identify if your child has features of invasive group A strep or other complications of Group A strep.

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Breathing that stops or pauses
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Unable to swallow saliva
  • Painful, red swollen neck glands
  • Painful, swollen joints
  • Puffy face or eyelids
  • Dark coca-cola coloured wee (urine)
  • Develops red lips or a red tongue
  • Develops a lot of skin peeling
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips or tongue
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Not using or putting weight on an arm, leg, hand or foot.
  • Complaining of severe pain that is not improving with painkillers
  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse or you are worried about them

You need to contact a doctor or nurse today.

Please ring your GP surgery or call NHS 111 - dial 111

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If none of the above features are present

  • Watch them closely for any change and look out for any red or amber symptoms
  • If your child has any other symptoms associated with their fever, you may want to look at the information on sore throatcoughearachediarrhoea and vomiting or tummy ache or our other pathways.
  • Additional advice is also available to young families for coping with crying of well babies – click here.
  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you. 


Self care

Continue providing your child’s care at home. If you are still concerned about your child, speak to your health visitorlocal pharmacist or call NHS 111– dial 111

Children and young people who are unwell and have a high temperature should stay at home. They can go back to school, college or childcare when they no longer have a high temperature, and they are well enough to attend.

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

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